To The Editor:After reading the article by Colwell et al., "Oral Direct Thrombin
Inhibitor Ximelagatran Compared with Warfarin for the Prevention of Venous
Thromboembolism After Total Knee Arthroplasty"
(2005;87:2169-77), we are
concerned that the facts presented by the authors do not appear to justify
their conclusions and that some important parameters of patient evaluations
are lacking.In this report, the authors note that 0.3% of the patients in the
ximelagatran group died from a cause in which pulmonary embolism could not be
ruled out whereas there were no deaths from pulmonary embolism in the warfarin
group. This incidence is relatively high when compared with that reported in
most recent studies, which have demonstrated a 0.1% incidence of fatal
pulmonary embolism following total joint surgery. More detailed information
regarding these deaths would be helpful to assist the reader in
differentiating the patients in whom pulmonary embolism could not be ruled out
from patients with fatal pulmonary embolism.